Healthcare Provider Details

I. General information

NPI: 1467654053
Provider Name (Legal Business Name): HEALTH VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ORIENTA AVENUE STE #1191
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

PO BOX 150038
ALTAMONTE SPRINGS FL
32715-0038
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-6236
  • Fax: 407-331-6953
Mailing address:
  • Phone: 407-331-6236
  • Fax: 407-331-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME85807
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME85807
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN PHILIP NIMBARGI
Title or Position: OWNER
Credential: MD
Phone: 407-782-3702